NewYou-Let’s Get Started

Congratulations! By saying Yes! to Sea Change New York’s NewYou, you have taken the first step to living your best year yet! Yes! to regaining your health, transforming your life and living your personal best in just 30 days.

Email back the completed registration form and I will call you within 24 hours to set up our “lets get started” phone consultation.

Please complete the information below and return the completed form and payment to me at:

Dr. Deborah Musso

drmusso@seachangeny.com

Fax: (212) 260-3261

Tel: (212) 889-7300

430 East 20th St. |New York, NY | 10009

Name:

Billing address:

City:

Best contact phone number:

(_____________)

Best e-mail address:

Select your preferred program (choose one): Self-directed ($195) or Doctor-supervised ($395)

Payment Options:

Check:  I will promptly mail a check to Dr. Deborah Musso for $________ to the address at the top.

Visa or Master Card:  I authorize Dr. Deborah Musso to bill my credit card for  $__________________

Card Number:

Exp Date:

V-Code:

Because I care about my friends and family, here are their names and e-mail addresses. Please invite them to participate in the NewYou program and tell them I said to “Just do it!” After all, if not right now, when?

[1](Name)

(E-mail address)

[2](Name)

(E-mail address)

[3] (Name)

(E-mail address)

[4] (Name)

(E-mail address)

Count On It,

Dr. Deb Musso

(212) 889-7300A |www.seachangeny.com